Critical Engagement
The Community Health Educator Model
as a participatory strategy for
promoting minority ethnic health
Dr. Lai Fong Chiu
Senior Research Fellow
Institute of Health Sciences and Public Health Research
University of Leeds
Background
• Concerns over access to health services e.g.
cancer screening programmes
• Beyond language and cultural barriers
addressed by previous model:
Linkworkers/Liaison officers (hospital based),
focus on interpreting, translation and cultural
practice.
• CHE model: community based, focus on
empowerment and participation.
The knowledge base of the CHE model
•
Communicating Breast Screening Messages to Minority Women:
Constructing a Community Health Education Model (1990-1993)
• Woman-to-Woman: Promoting Cervical Screening among
Minority Ethnic Women in Primary Care (1994-1997)
• Straight Talking: Communicating Breast Screening
Information in Primary Care (1999-2001)
• C4H (Communication for Health): the efficacy of
participation videos in promoting access to breast
screening information among South Asian and Chinese
communities (2004 – September, 2005)
What is the Community Health Educator Model?
•
Some basic concepts
– The recruitment and training of lay people in the community
to deliver health promotion /education and screening support
work
– Problem or issue focus
– Embodied community, organisational and personal
development elements
Framework & key process for participation and
Partnership
Stage 1
Stage 2
Stage 3
Problem
Identification
Stage
Constructing
the intervention
programme
Implementation,
Monitoring, and
Evaluation
Focus groups/
Training CHEs
to deliver
health
intervention.
Individual
interviews
Rapid
appraisal
Workshops
Training
Professionals
to work with
CHEs
REVIEW
Strong support
required from all
stakeholders e.g.
G.P. Practices,
Acute sectors &
Communities
Multi-methods
• Stage 1
Focus groups
• Stage 2
Action learning group and
training programmes
• Stage 3
quasi- experimental
Interviews & Focus groups
Stage 1
Stage 1
Research Outcomes
CHEs (Cantonese,
English, Mirpuri and
Syhleti) trained to
conduct focus
groups
•Information and communication needs
Professionals:
eg.practice nurses
•The effectiveness of current information
and dissemination strategies
focus groups
•.Other personal and cultural factors
affecting access in relation to the
particular issue in hand (e.g. cancer
screening, immunisation, diabetes)
Stage 2
Action:
• Constructing the intervention
programme
• Training CHEs on the issue in
question
• Training Professionals to work
with CHEs
• Planning for implementation
Consequences:
 An intervention strategy
and plan based on needs
 Capacity building of CHEs
 Empowering CHEs
 Confronting system
barriers
A recent training programme of a CHE project
Content includes…
• Introduction to CHE programme and health promotion
• Reproductive health
• You and the NHS*
• Cancer Education
• Skills in community health education and promotion
• Self empowerment and community health development
• The NHS Breast Screening Programme
• Evaluation
• Using health education resources ….. (Visits)
Stage 3 Implementation & evaluation
 Stakeholders buy-in e.g. hospital doctors, general
practitioners
 Management needs to understand the principle of the
model
 Focussed on both tangible outcomes of the
intervention programme and developmental
processes of the CHE scheme
 Qualitative and quantitative methods to collect data
for evaluation
 Reflective practice method to nurture and support
CHEs
Involvement in production of health education
materials
• Local knowledge is explicitly valued
• CHEs’ symbolic and cultural resources (dual system)
are not taken for granted but viewed as strategies
and instruments in democratising health knowledge
– Production of photostories
– Contributing to CHE training materials
Telling their own stories
Languages available
Urdu
Chinese
Bengali
English
A vehicle for empowerment
• Enhanced existing social knowledge and skills in
communities
• Improved access to knowledge (e.g. about the NHS
and cancer screening) and new skills (health
promotion and education e.g. one to one; group;
organisational; campaigning)
• Problem solving and support for personal
development through critical reflective sessions.
• Improved confidence generalisable to many aspects
of life
Theoretical and practical contributions
• The inter-connectedness of theoretical concepts i.e.
symbolic power, agency, lay knowledge, community
resources, social networks and social capital.
• Valuing different ethnic identities
• The notion of agency becomes tangible with the
practice of the CHE model.
• Engagement with different communities can enhance
social cohesion.
Limitations on the development of the model
• Changes in the system are difficult.
• Demand for evidence based practice, but evidence from
practice is not valued.
• The focus on conventional outcomes in evaluation (quick fix for
uptake rates or waiting lists).
• Ignore developmental processes
• Rethinking of evaluation research methodology and practice in
health intervention
– Simplistic - complex and pluralistic evaluation.
– Process of learning-for-all versus concerns over outcomes
Conclusions
• The CHE model not only has the potential to
improve access to services and intercultural care,
but also to act as a practical programme for social
inclusion.
• The model is an action learning programme for all
concerned.
• Developing the CHE model requires a fundamental
change of the ways in which we think about people,
organisation and practice, and the knowledge we
purport to have about them.